THE DIFFERENCE IN ACTIVITIES OF DAILY LIVING (ADL) EVALUATED BY FAMILY AND BY MEDICAL STAFF FOR THE ELDERLY AT A FACILITY OF HEALTH CARE SERVICE AT A HEALTH CARE SERVICE FACILITY

Abstract

We investigated the difference in Activities of Daily Living (ADL) which was evaluated separately by the patient's family and by medical staff for aged people who were admitted to a facility of health care services for the elderly. One hundred eighty-eight subjects, 85 men and 103 women (mean age 82.8 years), were studied. On admission 7 values of ADL, feeding, toileting, dressing, grooming, bathing, locomotion and communication, were evaluated by the subject's family after admission the subject were evaluated again by the medical staff, which consisted of physicians, nurses, physical therapist, and others. Subsecguently both ADL reaults were compared. The effect of whether a patient was admitted directly from his home or transferred from another hospital on ADL evaluation was also studied. a study of the effect on ADL evaluated according to the underlying morbidity, fracture, stroke, and others, was conducted as well. Evaluation for ADL was assigned to three levels: Total Independence (TI), Partial Independence (PI), and Total Dependence (TD) ADL evaluated by the family was compared with that by medical staff using an χ² test, and the coincidence rate was analysed.
The coincidence rate of the ADL evaluated by the family and by medical staff was 47.6%. ADL Discrepancy was observed in bathing and dressing. For the coincidence rate, no difference was observed between those who were admitted directly from them homes and those who were transferred from other hospitals. The coincidence rate for fracture and anotter morbidity group was significantly lower than that of the stroke group (p<0.05) .
The overall coincidence rate was less than 50% the reason for this discrepancy in bathing, which requires a great deal of assistance, and dressing, which requires less assistance, is most likely attributed to the difference in manpower and equripnant for the former and time consumed for the later. In addition, the reason that the discrepancy was significant in the ADL for bathing, which needs a lot of assistance, appears to be that hemiplegia due to a stroke is more likely to impress a family as being a severe disability compared to a fracture and aging, The difference of ADL evaluation between the family and medical staff suggests a gap regarding the significance of ADL and a gap between care and assistance for the disabled. A physician should carefully consider care and welfare service which the patient receives, after having compared his own evaluation for the patient's ADL with that of the family.